Robert Mentzer column: What it's like to go without health insurance

Feb. 19, 2013

For some, health care services are all but out of reach. / Gannett Wisconsin Media file photo

Story No. 1: Nine years ago, when Jasmin Voelz was 20, she woke up screaming, pain like a knife in her gut. She lay on the floor in her apartment, crying, for eight hours before her friends forced her to go to the doctor.

She hadn’t wanted to go. She had no insurance and feared the cost of medical bills.

It was appendicitis. In an interview last week, Voelz, who lives in Wausau, said her friends got her to the emergency room “just in time” — because acute, untreated appendicitis kills people. It happens all the time.

All told, Voelz’s medical bills came to about $20,000. She was working at the time and has been employed steadily since then, but her jobs — bartending, working the night desk at a hospital — tend not to provide insurance. She doesn’t have family support. She’s still paying off the debt she incurred for no reason except that her appendix, a useless internal organ, decided it was time to burst.

Voelz is No. 25,566 on the state’s BadgerCare waiting list.

Story No. 2: When Shalaina Aaron, 36, of Schofield worked at Kraft Foods on Wausau’s southeast side, most days she walked four miles round trip to get to her job. Today, she says she can’t work and is seeking federal disability status.

Aaron owes $50,000 from the time she broke her leg and had it set in a cast at a local hospital. Her other foot sprains and resprains. She has a pinched sciatic nerve that causes her pain every day. She’s just recovered from cervical cancer. She struggles with serious depression.

Aaron is No. 66,539 on the state’s BadgerCare waiting list.

Story No. 3: Mike Berk worked at Taco Bell and other fast food restaurants before he decided to go back to school to develop new skills. Today, the 24-year-old Wausau resident is a full-time student at Northcentral Technical College. He has abdominal pains that get so bad he has to stop what he’s doing, double over, and put pressure on his stomach. He can’t afford to pay for a doctor’s visit, he said, and even if he could, what would be the point? He couldn’t afford the medications, specialist visits or, God forbid, surgery that a doctor might order.

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Berk is No. 80,142 on the state’s BadgerCare waiting list.

A complex, risky plan

The first part of Gov. Scott Walker’s plan to expand BadgerCare coverage in Wisconsin is to kick bunch of people — about 230,000 — off BadgerCare.

Walker announced the plan last week at the same time he announced that he would turn down federal funding available through the health care reform law to expand the state’s low-income health insurance program.

The people who will be kicked off BadgerCare are childless adults who earn between 100 percent and 200 percent of the federal poverty rate. Instead, those people will receive coverage through the federal health exchanges, the highly regulated private markets created by Obamacare. (It’s a sign of the weirdness of our political moment that Walker’s plan is seen as a rejection of Obamacare when it is entirely reliant on that law.) That will open up space to expand BadgerCare for about 225,000 who are currently uninsured. The program has had its enrollment capped since 2009 — hence those high waiting-list numbers.

I sat down with Voelz, Aaron and Berk last week in the afternoon of the day the governor announced his decision. They were participants in a push by the liberal advocacy group Wisconsin Jobs Now to persuade Walker to go the other way.

The governor’s plan could work. But the ways it could go wrong are legion. Last Wednesday, health policy analyst Bob Laszewski called the plan “crazy policy” in an interview with The Associated Press, arguing that the people just barely above the poverty line will be in no shape to afford the private insurance plans available on the exchange. Those will cost around 6.3 percent of some monthly incomes, according to projections.

Whatever else you think of it, Obamacare’s Medicaid expansion is fairly straightforward: The feds pay the cost for states to cover more people through Medicaid — known in Wisconsin as BadgerCare.

And whatever else you think of it, Walker’s plan is a complicated — and, it seems to me, risky — double-bankshot way of getting there. Like I said, it could work. But all the gears and creaky mechanisms in an already frustratingly complex and dysfunctional bureaucracy would have to work juuuust right.

I asked Voelz, Aaron and Berk if they had hope that one way or another Walker’s changes might benefit them. Yes, a bit. But they feel it’s more likely that they’ll just end up shunted from one waiting list to another, offered one unaffordable option or another, or promised some new program that’s always going to be just out of their reach.

Meanwhile, they’ll carry with them their cases of appendicitis, their chronic back pain, their mysterious stomach ailments, their medical debts; casualties of a fight they didn’t choose and can’t control.